Beginning in 2025, the Medicare Prescription Payment Plan (MPPP) will allow Part D beneficiaries to spread their out-of-pocket (OOP) costs over the course of the plan year. This program is expected to help some enrollees better manage their OOP costs, especially those who experience high costs early in the year. At the same time, it also brings new complexities in navigating Part D benefits that could require additional patient education and assistance. CMS recently released a new MPPP landing page on Medicare.gov, in addition to a fact sheet and takeaway card.

Part D Enrollee Experience and Key Considerations

The MPPP is a voluntary, opt-in program for Part D beneficiaries. In 2025, it will launch with other significant changes to the Part D benefit, which may be overwhelming for beneficiaries and caregivers. Given these changes and opt requirements, widespread MPPP education and outreach to beneficiaries will support informed decision making about plan choices and whether to participate in the MPPP.

Who Will Benefit? The Part D enrollees who are most likely to benefit from the MPPP are those that face high OOP costs in a short period of time or early in the plan year. CMS has identified a “likely to benefit” threshold for beneficiaries that have OOP costs for a single script at or above $600 during the plan year. Plans and pharmacies will be required to notify these Part D enrollees and provide additional information about the MPPP.

Who May Not Benefit? Other beneficiaries may not see as much benefit from the MPPP, such as those who already have low, predictable copays for their medications or those who receive “Extra Help” (also known as the low-income subsidy or LIS). These beneficiaries may see lower costs initially, but MPPP participation would defer those payments to accumulate later in the year. Additionally, it may not make sense to opt into the MPPP in the last few months of the year when there are fewer remaining months over which to spread costs.

How Does It Work? Once a beneficiary opts in to MPPP, either prior to or during the plan year, they will pay nothing up front at the pharmacy counter. Instead, the OOP costs will be split into monthly payments and the Part D plan will bill the enrollee each month. The monthly amounts billed may change depending on additional OOP costs that a Part D enrollee incurs during the plan year.

What If a Payment Is Missed? If a beneficiary misses their monthly MPPP payments after notices from their plan and a two-month grace period, they risk being removed from the MPPP and could be prevented from re-enrolling in future years under their plan. Importantly though, patients cannot be disenrolled from their Part D plan.

Ultimately, Part D enrollees will need to evaluate their individual circumstances, with the support of educational resources, to decide if the MPPP is right for them.

Role of Patient Groups

The MPPP is a new offering in 2025, among other changes occurring in the Part D benefit, that together will represent some of the most significant year over year differences since the program was first implemented. Therefore, 2025 brings an increased need for accurate, timely, and personalized assistance for Part D enrollees to assess their options. Patient groups can play a key role in providing clear communication about program changes directly to beneficiaries by developing and sharing educational resources. Patient groups can also provide more direct and tailored support to Part D enrollees. This support may include tools to help enrollees determine whether the MPPP is right for them and preparing call centers to answer questions about the program.

These education and outreach efforts from patient groups will be an important resource to help beneficiaries learn about the MPPP and ensure that Part D enrollees who may benefit most from the program enroll in it.

Dive Deeper

This Insight is part of a broader series in which Avalere explores how the MPPP will reshape the landscape for Part D stakeholders, including manufacturers, Part D plans, and pharmacies and other providers. Read the first installment of the series here.

For support in navigating the changing Medicare Part D landscape, connect with us.